Cannon Christopher P
Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Rev Cardiovasc Med. 2007;8 Suppl 3:S27-34.
Clopidogrel has demonstrated improved outcomes for patients with acute coronary syndromes in several large randomized controlled trials. However, some questions exist about the use of clopidogrel in practice. Who benefits from clopidogrel? When should clopidogrel treatment be initiated? How much clopidogrel should be administered and for how long? Reviewing the results from trials completed to date that have assessed clopidogrel in patients with acute coronary syndromes may help to answer some of these questions. Clinical trial results have demonstrated a reduction in the composite endpoint of death, myocardial infarction, or stroke for patients with acute coronary syndromes who received clopidogrel plus aspirin compared with aspirin alone. For this patient population, early treatment with clopidogrel more than 6 hours before percutaneous coronary intervention (PCI) was associated with a reduction in the risk of death or recurrent ischemic events. The benefits of initiating patients on a 600-mg loading dose of clopidogrel before PCI have been demonstrated in several clinical trials. Clinical trial results and current guidelines recommend long-term treatment with clopidogrel for up to 1 year after PCI.
在多项大型随机对照试验中，氯吡格雷已证明可改善急性冠脉综合征患者的预后。然而，在实际应用中，关于氯吡格雷的使用仍存在一些问题。哪些患者能从氯吡格雷中获益？氯吡格雷治疗应何时开始？应给予多少剂量的氯吡格雷以及持续多长时间？回顾迄今为止完成的评估急性冠脉综合征患者使用氯吡格雷的试验结果，可能有助于回答其中一些问题。临床试验结果表明，与单独使用阿司匹林相比，接受氯吡格雷加阿司匹林治疗的急性冠脉综合征患者的死亡、心肌梗死或中风复合终点有所降低。对于该患者群体，在经皮冠状动脉介入治疗（PCI）前6小时以上早期使用氯吡格雷与死亡或复发性缺血事件风险降低相关。在多项临床试验中已证明在PCI前给予患者600毫克负荷剂量氯吡格雷的益处。临床试验结果和现行指南推荐PCI后使用氯吡格雷进行长达1年的长期治疗。
